Target-close electromagnetic energy emitting device

ABSTRACT

An apparatus having an excitation source that includes at least one laser diode and also having a handpiece with a disposable, bendable tip cannula is disclosed.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/921,057, filed Mar. 29, 2007 and entitled TARGET-CLOSEELECTROMAGNETIC ENERGY EMITTING DEVICE. This application is acontinuation-in-part of U.S. application Ser. No. 11/698,345, filed Jan.25, 2007 and entitled ELECTROMAGNETIC ENERGY OUTPUT SYSTEM), the entirecontents of both which are hereby incorporated by reference.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates generally to devices for generating outputoptical energy distributions and, more particularly, to lasers.

2. Description of Related Art

A variety of laser systems have existed in the prior art. A solid-statelaser system generally comprises a laser rod for emitting coherent lightand a stimulation source for stimulating the laser rod to emit thecoherent light. Flashlamps are typically used as stimulation sources forlaser systems, for example, but diodes may be used as well for theexcitation source. The use of diodes for generating light amplificationby stimulated emission is discussed in the book Solid-State LaserEngineering, Fourth Extensively Revised and Updated Edition, by WalterKoechner, published in 1996, the contents of which are expresslyincorporated herein by reference.

With reference to FIG. 1, a conventional laser assembly 25 may comprisea housing 27 containing a laser module 29, which is connected by way ofan optical connector 31 to a trunk fiber 33. The optical connector 31 istypically disposed within and concealed by a portion of the housing 27and, further, is typically constructed to facilitate attachment andremoval of the trunk fiber 33 to and from the housing 27. Moreover, inthe illustrated prior-art example, the trunk fiber 33 extends in anuninterrupted fashion from the housing 27 up to and through a handpiece35. Furthermore, the trunk fiber 33 continues in an uninterruptedfashion from the handpiece 35 through a pre-bent tip cannula 38 andterminates at an energy output end 40 of the trunk fiber 33. Thepre-bent tip cannula 38 comprises a rigid plastic or a stainless steelmaterial.

A spool (not shown) can be disposed in close proximity to the opticalconnector 31, for storing extra trunk fiber 33. The spool can be securedto the housing 27 to provide a user with access and to enable the userto increase a length of the trunk fiber 33 by advancing addition trunkfiber 33 from the spool toward the handpiece 35. In typicalimplementations, the energy output end 40 of the trunk fiber 33 canexhibit signs of wear or damage after use, and thus should be replacedon a regular and frequent basis. To this end, after each use, the userwill typically need to cleave a portion (e.g., between 3 and 10millimeters) off of the energy output end 40 of the trunk fiber 33 andadvance an additional length of trunk fiber 33 from the spool tocompensate for the decrease in length of the trunk fiber 33 caused bythe cleaving. Of course, to facilitate this functionality, the trunkfiber 33 must be slidably disposed, and cannot be permanently affixedsuch as by an adhesive, within the pre-pent tip cannula 38. Using thistechnique, a trunk fiber 33 length of, for example, 10 to 12 feet can bemaintained. Additionally, for sanitation purposes, the pre-bent tipcannula and any other appropriate components are typically sterilized,such as by autoclaving, on a regular and frequent basis.

FIG. 2 illustrates a plot of energy versus time for an output opticalenergy waveform 43 of a prior-art laser, such as the conventional laserassembly 25 depicted in FIG. 1. The output optical energy waveform 43may be generated by a compact diode laser, such as a SIROlaser,manufactured by Sirona Dental Systems GmbH, of Germany, having a URL ofwww.sirona.com, operable at a wavelength of 980 nanometers and arepetition rate of about 10 kHz, and having an average power output,defined as the power delivered over a predetermined period of time,varying from 0.5 to 7 W. Each pulse of the depicted output opticalenergy waveform 43 has a pulse duration 46 and a pulse interval 48. Inthe illustrated example, the output optical energy waveform 43 can begenerated such that the pulse duration 46 can have a value of about 50microseconds and the pulse interval 48 can also have a value of about 50microseconds. According to the exemplary depiction, the output opticalenergy waveform 43 can be said to have a pulse period 51 of about 100microseconds, and, furthermore, the output optical energy waveform 43can be said to have a pulse duty cycle, defined as the pulse duration 46divided by the pulse interval 48, of about 50%. The pulse duration 46and the pulse duration 48 of this exemplary prior-art system cannot beindependently adjusted.

Another prior-art system is the LaserSmile™ laser, manufactured byBIOLASE Technology, Inc., of Irvine, Calif., having a URL ofwww.biolase.com. This laser can be operated at a wavelength of 810nanometers and a repetition rate of, for example, about 0.01 to about 5Hz, with corresponding pulse durations of about 0.02 to about 9.9seconds, and with an average power output up to about 10 W. Outputoptical energy waveforms from the laser can have pulse duty cycles of,for example, between 10% and 50%. Additionally, while beingindependently adjustable, the pulse duration and pulse interval of thelaser's output optical energy waveform tend to be relatively large andnot adequately or optimally suited for a number of soft tissue cuttingprocedures, such as procedures designed to minimize an impartation ofthermal energy into the target soft tissue.

SUMMARY OF THE INVENTION

The present invention provides an apparatus having an excitation sourcethat includes at least one laser diode and also having a handpiece witha disposable, bendable tip cannula.

While the apparatus and method have or will be described for the sake ofgrammatical fluidity with functional explanations, it is to be expresslyunderstood that the claims, unless expressly formulated under 35 USC112, are not to be construed as necessarily limited in any way by theconstruction of “means” or “steps” limitations, but are to be accordedthe full scope of the meaning and equivalents of the definition providedby the claims under the judicial doctrine of equivalents, and in thecase where the claims are expressly formulated under 35 USC 112 are tobe accorded full statutory equivalents under 35 USC 112.

Any feature or combination of features described herein are includedwithin the scope of the present invention provided that the featuresincluded in any such combination are not mutually inconsistent as willbe apparent from the context, this specification, and the knowledge ofone skilled in the art. In addition, any feature or combination offeatures may be specifically excluded from any embodiment of the presentinvention. For purposes of summarizing the present invention, certainaspects, advantages and novel features of the present invention aredescribed. Of course, it is to be understood that not necessarily allsuch aspects, advantages or features will be embodied in any particularimplementation of the present invention. Additional advantages andaspects of the present invention are apparent in the following detaileddescription and claims that follow.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows a conventional laser assembly;

FIG. 2 illustrates a plot of energy versus time for an output opticalenergy waveform of a prior-art laser;

FIG. 3 depicts an electromagnetic energy output device according to thepresent invention;

FIGS. 4A and 5 illustrate plots of energy versus time for output opticalenergy waveforms, according to the present invention, that can beoutputted by an electromagnetic energy output system such as the lasermodule depicted in FIG. 3;

FIG. 4B is a magnified view of the plot of energy versus time for theoutput optical energy waveform of FIG. 4A;

FIG. 6 is a side-elevation view of an exemplary output tip comprising anoutput fiberoptic, a bendable tip cannula, and a ferrule;

FIG. 7 is a cross-sectional view of the output tip shown in FIG. 6,secured to a handpiece;

FIG. 8A is a side-elevation view of the output tip of FIG. 6 connectedto a handpiece;

FIG. 8B is a cross-sectional view of the assembly of FIG. 8A;

FIG. 9A shows a side-elevation view of an outer layer of the handpieceof FIGS. 8A and 8B;

FIG. 9B shows a side-elevation view of the outer layer along with acoupling member;

FIG. 9C shows a side-elevation view of the outer layer and couplingmember, a cross-sectional view of the outer layer and coupling member,and a perspective view of the outer layer;

FIG. 10 is a magnified view of portions of the structure of FIG. 8B;

FIG. 10A is a perspective view depicting an inner assembly, which isalso shown in FIG. 8B and which includes the output tip;

FIG. 10B is an exploded, perspective view of the assembly of FIG. 10A;

FIG. 10C is a partially-assembled view of the components depicted inFIG. 10B;

FIG. 11 is a schematic representation of the portion depicted in FIG.10;

FIG. 12 is a schematic representation of the portion depicted in FIG. 10according to a modified embodiment;

FIGS. 12A, 12B, 12C and 12D show perspective, lengthwisecross-sectional, front-end, and transverse cross-sectional views ofcomponents including a ferrule 112 corresponding to the representationof FIG. 12.

FIGS. 12E and 12F show side-elevation views of components including aferrule and an output fiberoptic 107;

FIG. 12G shows a perspective view of components including a ferrule andan output fiberoptic 107, with an aiming beam in an “on” state so thatexposed parts of the output fiberoptic and ferrule glow;

FIG. 12H provides schematic representations of aiming-beamcharacteristics, of a portion of structure depicted in FIG. 10, and oflaser and aiming-beam spots projected onto the input end of an outputfiberoptic;

FIG. 13 depicts an irradiation pattern that may be generated and outputfrom the embodiment of FIG. 12;

FIG. 14 shows examples of a number of typical bendable tip cannulasaccording to the present invention;

FIG. 15 depicts a body-mount implementation of an electromagnetic energyoutput device according to an aspect of the present invention;

FIGS. 16 and 17 are perspective front and rear views, according to anaspect of the present invention, of an electromagnetic energy outputdevice in the form of a compact, portable assembly that can be carriedor mounted with relative ease by a user.

FIG. 18 shows the electromagnetic energy output device of FIGS. 16 and17 in a wall-mount configuration according to an aspect of the presentinvention;

FIG. 19 shows the electromagnetic energy output device of FIGS. 16 and17 with a detached base according to an aspect of the present invention;

FIG. 20A shows the electromagnetic energy output device of FIGS. 16 and17, disposed on a flat surface such as a table top according to anaspect of the present invention;

FIG. 20B is a rear view of the electromagnetic energy output device ofFIGS. 16 and 17, held by a hand of a user according to another aspect ofthe present invention;

FIGS. 21-25B depict various perspective views of spool structures andassociated techniques corresponding to aspects of the present invention;

FIGS. 26A-26B depict front and rear perspective views of a modified-baseimplementation according to an aspect of the present invention; and

FIGS. 27-44 depict a sundry of body-mount assemblies and components ofembodiments of the electromagnetic energy output device according tovarious aspects of the present invention.

DETAILED DESCRIPTION OF THE PRESENT INVENTION

Reference will now be made in detail to particular embodiments of theinvention, examples of which are illustrated in the accompanyingdrawings. Wherever possible, the same or similar reference numbers areused in the drawings and the description to refer to the same or likeparts. It should be noted that the drawings are in simplified form andare not to precise scale. In reference to the disclosure herein, forpurposes of convenience and clarity only, directional terms, such as,top, bottom, left, right, up, down, over, above, below, beneath, rear,and front, are used with respect to the accompanying drawings. Suchdirectional terms should not be construed to limit the scope of theinvention in any manner.

Although the disclosure herein refers to certain illustratedembodiments, it is to be understood that these embodiments are presentedby way of example and not by way of limitation. The intent of thisdisclosure, while discussing exemplary embodiments, is that thefollowing detailed description be construed to cover all modifications,alternatives, and equivalents of the embodiments as may fall within thespirit and scope of the invention as defined by the appended claims.

An electromagnetic energy output device is disclosed for implementingprocedures on hard or soft tissue. The electromagnetic energy outputdevice can be configured, for example, to be particularly suited forsoft tissue cutting or ablating procedures, and also fordecontamination, cleaning periodontal pockets, pain reduction, andbiostimulation procedures.

With reference to FIG. 3, an embodiment of the current inventioncomprises an electromagnetic energy output device 65 having a system 67,such as a diode laser system. The system 67 in the illustratedembodiment can comprise a laser module 69, which, in accordance with oneaspect of the present invention, can be directly coupled to a trunkoptical fiber 73. According to one implementation and one aspect of theinvention, the trunk optical fiber 73 can be permanently coupled to thesystem 67. According to another embodiment and aspect of the invention,the trunk optical fiber 73 can also, or alternatively, be permanentlycoupled to the laser module 69 within the system 67.

The trunk optical fiber 73 in the illustrated embodiment, and accordingto another aspect of the invention, extends from a permanent connection75 at the laser module 69 all of the way to a handpiece 78. Furthermore,in a typical embodiment, the trunk optical fiber 73 extends a furtherdistance through at least a part of the handpiece 78. In the illustratedembodiment, the trunk optical fiber 73 extends through substantially allof the handpiece 78 and terminates at an energy output end 80 of thetrunk fiber 73, in a vicinity of a distal handpiece end 81 of thehandpiece 78.

A diode (not shown) within the laser module 69 can be driven by a diodecurrent, which can comprise a predetermined pulse shape and apredetermined frequency. The diode current can drive a diode, or diodearray, at the predetermined frequency, to thereby produce an outputdiode light distribution having, for example, substantially the samefrequency as the diode current. This output diode light distributionfrom the diode can drive a laser rod (not shown) to produce coherentlight at substantially the same predetermined frequency as the diodecurrent. The coherent light generated by the laser rod can have, forexample, an output optical energy distribution over time that generallycorresponds to the pulse shape of the diode current. The pulse shape ofthe output optical energy distribution over time typically comprise arelatively steep rising energy that ramps to a maximum energy levelfollowed by a subsequent decreasing energy over time.

The laser module 69 may comprise a solid-state laser rod pumping moduleand a stack-type semiconductor laser. The semiconductor laser can bebased on a semiconductor gain media, where optical gain is generallyachieved by stimulated emission at an interband transition underconditions of an inversion (i.e., high carrier density in the conductionband). The semiconductor laser can be a laser diode, which is pumped byan electrical current in a region where n-doped and p-dopedsemiconductor materials meet. In certain embodiments, optically pumpedsemiconductor lasers, where carriers are generated by absorbed pumplight, can be used. In the case of, for example, a stack-typesemiconductor laser, it can include a plurality of bar-shaped componentsthat are stacked in a direction parallel to the axis of a solid-statelaser rod. Each bar-shaped component can include a plurality oflaser-light-emitting portions that are aligned and integrated in adirection orthogonal to the axis of the solid-state laser rod. The largedivergence angle of the stack-type semiconductor can be compensated byincluding a light focusing component for focusing laser light emittedout of the stack-type semiconductor laser, and the focused light can beguided by a laser light guiding component disposed in a diffusivereflection tube. Thus, a light guiding component can guide focused lightonto the solid-state laser rod located within the diffusive reflectivetube, while maintaining the length of one side of the cross section ofthe guided light.

The semiconductor laser or other optoelectronic device can comprise, forexample, a Indium Gallium Arsenide (GaAs) material. In an exemplaryimplementation, the gain medium can comprise a laser rod, such as aconfiguration comprising an active heterostructure and substrate ofAlGa(In)As/GaAs, wherein the Ga of the active heterostructure can besubstituted for and/or combined with In. Another exemplaryimplementation can comprise AlGaInP(As)/GaAs, wherein the P of theactive heterostructure can be substituted for and/or combined.

FIG. 4A illustrates a plot of energy versus time for an output opticalenergy waveform 93, according to the present invention, that can beoutputted by an electromagnetic energy output system, such as the lasermodule 69 depicted in FIG. 3. FIG. 4B is a magnified view of the plot ofenergy versus time for the output optical energy waveform 93 of FIG. 4A.

Each of the pulses of the output optical energy waveform 93 comprises aplurality of micropulses. The micropulses correspond to populationinversions within the laser rod as coherent light is generated bystimulated emission. Particles, such as electrons, associated withimpurities of the laser rod absorb energy from the impinging incoherentradiation and rise to higher valence states. The particles that rise tometastable levels remain at this level for periods of time until, forexample, energy particles of the radiation excite stimulatedtransitions. The stimulation of a particle in the metastable level by anenergy particle results in both of the particles decaying to a groundstate and an emission of twin coherent photons (particles of energy).The twin coherent photons can resonate through the laser rod betweenmirrors at opposing ends of the laser rod, and can stimulate otherparticles on the metastable level, to thereby generate subsequent twincoherent photon emissions. This process is referred to as lightamplification by stimulated emission. With this process, a twin pair ofcoherent photons will contact two particles on the metastable level, tothereby yield four coherent photons. Subsequently, the four coherentphotons will collide with other particles on the metastable level tothereby yield eight coherent photons.

The amplification effect will continue until a majority of particles,which were raised to the metastable level by the stimulating incoherentlight from the diode, have decayed back to the ground state. The decayof a majority of particles from the metastable state to the ground stateresults in the generation of a large number of photons, corresponding toan upwardly rising micropulse. As the particles on the ground level areagain stimulated back up to the metastable state, the number of photonsbeing emitted decreases, corresponding to a downward slope in themicropulse. The micropulse continues to decline, corresponding to adecrease in the emission of coherent photons by the laser system. Thenumber of particles stimulated to the metastable level increases to anamount where the stimulated emissions occur at a level sufficient toincrease the number of coherent photons generated. As the generation ofcoherent photons increases, and particles on the metastable level decay,the number of coherent photons increases, corresponding to an upwardlyrising micropulse.

The output optical energy waveform 93 according to an aspect of theinvention is generated by a diode laser to have a wavelength, pulse, andpower density suitable for cutting and ablating, for example, softtissue. The diode light pump or the at least one diode can comprise adiode array, and the diode or diode array can be optically aligned toside pump the gain medium. In one implementation, the diode light pumpcan be placed, for example, within an optical cavity so that the diodeor diode array is optically aligned to side pump the gain medium.Generation of the output optical energy waveform 93 can be accomplished,for example, in the TEMoo mode to attenuate or overcome thermal effects.

With reference to FIGS. 4A and 4B, the output optical energy waveform 93according to an aspect of the invention is generated by a diode laser tohave a wavelength of 940 nanometers, and can be delivered, for example,in a CW (continuous wave) or a QCW (quasi-continuous wave) mode ofoperation. As presently embodied, the output optical energy waveform 93is delivered in a pulsed-format mode of operation that is highlyrepetitive in time and intensity to provide, for example, relativelyprecise and predictable cutting. As compared, for example, to awavelength of 810 nanometers, with other things being equal, thewavelength of 940 nanometers has been determined by the presentinventors to have an absorption that is about four times greater forwater, two times greater for hemoglobin (for enhanced homeostasis) andabout 20% greater for oxyhemoglobin. Alternative wavelengths which canbe used according to modified aspects of the present invention can be,for example, 915 nanometers, 960 nanometers and 980 nanometers. Otheralternative wavelengths which can be used in other modified aspects ofthe invention can comprise the mentioned wavelengths, plus or minusabout 50 nanometers.

As shown in FIG. 4A, each pulse of the output optical energy waveform 93can comprise, for example, a pulse duration 96 of about 50 microseconds,a pulse interval 98 of about 450 microseconds, and a pulse period ofabout 500 microseconds. The magnified view of a pulse featured in FIG.4B shows that the pulse duration 96 has room for being further reducedin duration. For example, the pulse duration 96 can, according tocertain embodiments, be reduced from about 50 microseconds all of theway down to about 10 microseconds. Thus, as illustrated, the outputoptical energy waveform 93 can comprise a repetition rate of about 2kHz. The average power output, defined as the power delivered over apredetermined period of time, can be about 1 W. The repetition rate canalso be, for example, about 10 kHz, corresponding to a pulse period ofabout 100 microseconds. The full-width half-max of the pulse may beabout 50 to 100 microseconds. In accordance with a typical embodiment,the repetition rate can be varied from about 1 kHz to about 5 kHz, andthe average power output can be varied from about 0.5 W to about 1.5 W.In typical embodiments, the pulse length can be varied from about 50microseconds to about 1000 microseconds, and the pulse interval can bevaried from about 100 microseconds to about 2000 microseconds, whichparameters may correspond, for example, to pulse repetition rates ofabout 0.5 kHz to about 5 kHz. The depicted output optical energywaveform 93 thus has a pulse duration 96 and a pulse interval 98 whichare both on the order of tens of microseconds. The pulse period isindicated with reference designator number 101 in the depiction of FIG.4A. FIG. 5 shows an output optical energy waveform 104 comprising, forexample, a pulse duration 106 of about 500 microseconds and a pulseinterval 110 of about 50 microseconds.

According to the present invention, the system 67 of the currentinvention can be configured to implement output optical energy waveforms93 that minimize an impartation of thermal energy into the target tissue(e.g., soft tissue). As an example, the thermal diffusion time, orthermal relaxation time, for highly-absorbing soft tissue is about 150to 200 microseconds. Thus, according to an aspect of the presentinvention, for certain applications, the pulse duration of the opticalbeam (e.g., the output optical energy waveforms 93) can be approximatelyequal to or less than the thermal relaxation time, which will help toconfine or limit the amount of energy dissipation, or the area ofthermal affection, of the impingent energy footprint on or within thetreatment area. Pulse durations that are longer than the thermalrelaxation time can be less efficient and cause the spot to undesirablygrow by thermal diffusion. In one implementation, the pulse duration isset to have a value (e.g., 50 microseconds) that is less than thethermal relaxation time. In another implementation, the pulse intervalis set to have a value (e.g., 450 microseconds) that is equal to orgreater than the thermal relaxation time. Another implementation cancomprise a combination of these two aspects, wherein the pulse durationcan be set to be below the thermal relaxation time and the pulseinterval can be set to be equal to or greater than the thermalrelaxation time.

According to another aspect of the present invention, the output opticalenergy waveform 93 can be varied by way of independent adjustments toone or more of the pulse duration 96 and the pulse interval 98. By wayof providing independent adjustments to one or more of the pulseduration 96 and the pulse interval 98, and, preferably, both, the pulseduty cycle, defined as the pulse duration 96 divided by the pulseinterval 98, can be controlled. As presently embodied, the pulse dutycycle can be adjusted from, for example, about 5% to about 95%. Inparticular implementations, it may be varied, for example, from about10% to about 50%. Thus, the pulse duration can be set, independently of,for example, the pulse interval, to have a value (e.g., 50 microseconds)that is below the thermal relaxation time; the pulse interval can beset, independently of, for example, the pulse duration, to have a value(e.g., 450 microseconds) that is equal to or longer than the thermalrelaxation time; and/or the pulse duration and pulse interval can be setto be below, and equal to or greater than, the thermal relaxation time,respectively, to approach or achieve, for example, a characteristicreferred to as cold cutting.

Setting of the pulse duration and pulse interval as described in theforegoing paragraph can facilitate a type of cold-cutting tissueinteraction. Cold cutting may bring about certain characteristics oradvantages, as discussed below, while, on the other hand, noncold-cutting modes, or intermediate modes, may bring about additionalcharacteristics or advantages, a few of which are discussed below.

By controlling one or more of the pulse duration 96 and the pulseinterval 98, various procedural properties, such as bleeding, can becontrolled. For example, increasing the pulse duration independent of,for example, the pulse repetition rate, can operate to decrease bleedingor increase coagulation, as a result of proving a greater thermic effectto the target. The effect of such a mode (e.g., a thermic effect, whichmay tend, for example, to augment coagulation) can in some instancescreate greater scar tissue and/or impede the speed or quality of healingof a target. On the other hand, generating a cooler-cutting (e.g., coldcutting) effect, by, for example, outputting optical energy waveform 93with a reduced pulse duty cycle (and/or, for example, setting the pulseduration and/or pulse interval below, and/or equal to or greater than,the thermal relaxation time, respectively, as described herein) mayenable a treated region to heal better or faster, and/or may facilitateimplementation of a procedure with less pain to the patient.

Referring back to FIG. 3, an optical interface can be disposed at atermination of the trunk optical fiber 73 near the distal handpiece end81, wherein the optical interface can be constructed to provide anoptical pathway between the trunk optical fiber 73 and an outputfiberoptic 107 of an output tip 108. Thus, as presently embodied, thetrunk fiber 73 can extend in an uninterrupted fashion from the system 67up to and through the handpiece 78, terminating at or near the opticalinterface, which, in turn, can be located at or near the handpiecedistal end 81.

The optical interface can be disposed, for example, within and concealedwithin the handpiece distal end 81 as illustrated. The output tip 108can be removable in accordance with an aspect of the present invention.In a number of such embodiments, the handpiece distal end 81 and theoutput tip 108 can be constructed to interact in such a way as tofacilitate convenient and rapid attachment and removal of the output tip108 to and from the handpiece 78. The output tip 108 can additionally,or alternatively, be removed and interchanged with other output tips inaccordance with an aspect of the present invention.

According to another aspect of the current invention, the output tip 108can additionally, or alternatively, comprise a bendable tip cannula 109.Furthermore, according to yet another aspect of the invention, theoutput tip 108 can additionally, or alternatively, comprise a disposableoutput tip 108, which may or may not (according to various,non-interchangeable embodiments) comprise a cannula, which may or maynot (according to various, non-interchangeable embodiments) be bendable.In the case of a bendable tip cannula 109, it may comprise a pliablematerial, such as a pliable metal. According to typical implementationsof the bendable tip cannula 109, the bendable tip cannula 109 can bebent at any angle, can have various diameters and lengths, and/or can bepackaged, for example, pre-sterilized in a sealed, sterile package.

Regarding such a bendable tip cannula 109, the pliable material maycomprise, for example, a treated stainless steel material. The stainlesssteel material may be treated to make it bendable and/or to make it morereadily bendable without kinking. Following an exemplary treatment ofthe bendable tip cannula 109 while, for example, the bendable tipcannula 109 is in a pre-bent orientation (or following treatment of thematerial used to make the cannula before the cannula is formed), thebendable tip cannula 109 can be bent one or more times while remainingoperable. In certain implementations, the bendable tip cannula 109 canbe non-destructively bent multiple times at various angles (e.g., 30degrees, or 45 degrees) up to about 90 degrees from the pre-bent(straight) orientation, at about a 2 or 2.5 mm radius of curvature,without damage to structure or function. A 2 mm radius of curvature maybe obtained, for example, by bending the bendable tip cannula around acylindrical object having a diameter of about 4 mm.

In other implementations, the bendable tip cannula 109 can benon-destructively bent multiple times at various angles up to about 120degrees from the pre-bent (straight) orientation, at a 2.5 mm radius ofcurvature, without damage to structure or function of the bendable tipcannula. A 2.5 mm radius of curvature may be obtained, for example, bybending the bendable tip cannula around a cylindrical object having adiameter of about 5 mm.

In further implementations, the bendable tip cannula 109 can benon-destructively bent a relatively large number of times, at any of thereferenced angles and radiuses of curvatures, without affect to orattenuation in function. Other embodiments encompass bending thebendable tip cannula 109 a relatively large number of times, at any ofthe referenced angles and radiuses of curvatures, without compromise toits ability to operate in its normal or intended capability.

According to other implementations, the bendable tip cannula 109 can bebent a relatively large number of times to a maximum angle of about 120degrees from the pre-bent (straight) orientation, at a radius ofcurvature of about 2.5 mm, while remaining fully, or in otherembodiments substantially, or in other embodiment adequately, operable.In a typical embodiment, the relatively large number can be three, fouror five, but in modified embodiments smaller or larger numbers can beimplemented. A bendable stainless steel material that may be used toform the bendable tip cannula 109 can be obtained or purchased as aMetric Hypodermic Tube (e.g., Gage Sizes 18, 19 or 20) from SuperiorTube Company, of Carlsbad, Calif. New England Small Tube Corporation, ofLitchfield, N.H.

A side-elevation view of an exemplary output tip 108, comprising anoutput fiberoptic 107, a bendable tip cannula 109 and a ferrule 112 withthreads 113 a, is depicted in FIG. 6. The ferrule 112 may comprise, forexample, plastic (e.g., acrylic or polycarbonate) that is, for example,transparent to the laser beam. A cross sectional view of this output tip108, secured to the handpiece 78 via, for example, engagement of threads113 a of the output tip 108 with corresponding threads 113 b of an outerlayer 116 a of the handpiece 78, is shown in FIG. 7. FIG. 8A is aside-elevation view of the output tip 108 connected to the handpiece 78,and FIG. 8B is a cross-sectional view of the assembly of FIG. 8A. FIG.9A shows a side-elevation view of an outer layer 116 a of the handpiece87; FIG. 9B shows a side-elevation view of the outer layer 116 a alongwith a coupling member 116 b; and FIG. 9C shows a side-elevation view ofthe outer layer 116 a and coupling member 116 b, a cross-sectional viewof the outer layer 116 a and coupling member 116 b, and a perspectiveview of the outer layer 116 a.

As can be discerned from FIGS. 8B, 9B and 10A, the outer layer 116 a andcoupling member 116 b can be secured over an inner assembly 117including the output tip 108, cf. FIG. 10A, by moving the outer layer116 a and coupling member 116 b proximally over the inner assembly 117(i.e., moving over and around the output tip 108 and progressingproximally to a proximal end of the inner assembly 117). The threads 113a/113 b can then be coupled and, further, protuberances 120 a of theinner assembly 117 can be disposed within a recessed area 120 b of theouter layer 116 a. Release buttons 121 can be pressed by a hand of auser to release the protuberences 120 a from within the recessed area120 b to facilitate removal of the inner assembly 117 from within theouter layer 116 a and coupling member 116 b.

FIG. 10 is a magnified view of portions of the structure of FIG. 8B, andFIG. 10A is a perspective view of portions of the structure of FIG. 8B.The perspective view of FIG. 10A depicts the inner assembly 117including the output tip 108. FIG. 10B is an exploded, perspective viewof the assembly of FIG. 10A, and FIG. 10C is a partially-assembled viewof the components depicted in FIG. 10B. FIG. 11 is a schematicrepresentation of the portion depicted in FIG. 10.

As elucidated in FIG. 10, the optical interface can comprise, forexample, a physical barrier that is optically transparent, such as awindow 114 shown in FIGS. 10-12. An O-ring 118 can be used to facilitatepositioning and/or stabilization of the window 114. Additionally, oralternatively, one or more of the ferrule 112 and a similarly-shaped(e.g., of similar or the same material) ferrule 119 can function tocontact one or more corresponding sides of the window 114. The window114 can be readily removable and field replaceable using an attachmentscheme that does not rely on adhesives or permanent formations, whereinremoval of the output tip 108, ferrule 112, and/or additional componentscan provide access to the window 114 for removal or insertion thereof.Although modified implementations of the optical interface may compriselenses or other optical elements on one or both sides (e.g., proximaland distal sides) of the optical interface, the illustrated embodimentcomprises neither. According to this illustrated implementation andaspect of the invention, lens structure or functionality is not providedon either side of the window 114 to attenuate a risk of, for example,misalignment, leaking, and/or damage when the output tip 108 isinserted, removed or otherwise repositioned.

As can be seen from a review of FIGS. 10 and 11, each of the trunkoptical fiber, which is shown in FIG. 10 disposed within a channel 73 a,and the output fiberoptic 107, which is shown in FIG. 10 comprising aglass fiber 107 a encompassed within a jacket 107 b (e.g., a Teflon orpolyethylene jacket), can be spaced from a corresponding surface of thewindow 114. In the illustrated implementation, each of the trunk opticalfiber 73 and the output fiberoptic 107 can be spaced about 100 micronsfrom a corresponding surface of the window 114. A point on the perimeterof the distal end (i.e., output surface) of the trunk optical fiber 73can be referred to as a beginning point. Referring to FIG. 11, an angleof divergence A1, measured between the optical axis of the trunk opticalfiber 73 and a path of output energy extending from the beginning pointto an edge (i.e., perimeter edge) of the proximal end of the outputfiberoptic 107, can be about eight degrees. Although the proximal inputend of the output fiberoptic 107 does not contact the window 114,intermediate or outer portions of the ferrule 112 do, as can be seen inFIG. 10, to thereby ensure exact positioning of the output tip 108 witheach insertion of each output tip 108. In a modified embodiment, apush/twist/lock design, or a click or snap design, can be implementedinstead of the illustrated threaded design for securing the output tip108 to the handpiece 78.

In the depictions of, for example, FIGS. 7 and 10, an air gap 111 isdisposed between the output fiberoptic 107 and the bendable tip cannula109. FIG. 7 shows an embodiment wherein an aiming beam fiber 115delivers radiation to the optical interface (e.g., window 114) at a anangle or at a relatively steep angle (e.g., up to about 30 degrees, orup to about 45 degrees, or up to about 60 degrees, compared to the trunkoptical fiber 73 axis), and further depicts another (e.g., alternative)embodiment wherein the aiming beam 115 a delivers radiation to theoptical interface 114 along an axis that is substantially parallel tothe trunk optical fiber 73. Furthermore, in the illustrated embodimentsof, for example, FIGS. 7 and 10, an air gap 111 a is disposed betweenthe distal end of the aiming beam fiber 115 and the proximal side of thewindow 114 and is further disposed between the distal end of the trunkoptical fiber 73 and the proximal side of the window 114. Moreover, inthis illustrated embodiment, another air gap 111 b is disposed betweenthe distal side of the window 114 and the proximal end of the outputfiberoptic 107.

FIG. 12 is a schematic representation of the portion depicted in FIG. 10according to a modified embodiment, and FIG. 13 depicts an irradiationpattern that may be generated and output from the modified embodiment ofFIG. 12. In this embodiment, instead of the aiming beam fiber 115 beingconfigured to deliver radiation to the optical interface (e.g., window114) at a relatively steep angle as shown in FIG. 10, the aiming beamfiber 115 can be constructed to deliver radiation to the opticalinterface along a path that is substantially parallel to the trunkoptical fiber 73. In either implementation, aiming-beam light strikingwindow 114 inherently results in a portion of that light being deflected(e.g., leaking) into the ferrule 112. Now, when the ferrule 112 isformed of a material transparent to the laser beam, as mentioned above,the aiming-beam light (comprising visible light) within the ferrule 112can be seen by a user, resulting in an appearance of the ferrule 112glowing with, for example, the color of the aiming beam light. Accordingto one aspect of the present invention, introducing disturbances orother light deflecting structures or compositions within the ferrule 112and/or on the surface of the ferrule 112 (and/or increasing or alteringthe amount or angle, or, potentially, other aspects or characteristics)of aiming-beam light entering the ferrule 112 can alter (e.g., enhance,augment, or dramatically enhance) the glowing appearance of the ferrule112. For instance, the ferrule 112 may be constructed to have differentdegrees of transparency and/or different colors wherein ferrules (ofreplaceable output tips) can be formed to have increasing levels oftransparency and/or different colors. In FIG. 12F, the top, bottom-rightand bottom-left ferrules can be formed, for example, to have a bluetint, a yellow tint and no tint, respectively.

Furthermore, when another portion of the aiming-beam light is directedinto the glass fiber 107 a, as discussed previously, this other portionof light travels to the distal, output end of the glass fiber 107 a andcan be seen by a user, resulting in an appearance of the distal, outputend of the output fiberoptic 107 (e.g., the exposed glass fiber 107 a)glowing with the color of the aiming beam light. According to an aspectof the present invention, introducing surface disturbances or otheralterations in structure or material within or on the surface of thedistal, output end of the glass fiber 107 a can alter (e.g., enhance,augment, or dramatically enhance) the glowing appearance of the distal,output end of the glass fiber 107 a. For instance, the glass fiber 107 amay be constructed to have different degrees of transparency and/ordifferent colors. In a typical embodiment, however, the glass fiber 107a is formed of a material that is entirely or substantially completelytransparent to the cutting-beam wavelength (e.g., 940 nm).

As presently embodied, the jacket 107 b can be constructed, for example,to be transparent or semi-transparent, to thereby exhibit a glowingappearance corresponding to the color of the aiming beam light.According to an aspect of the present invention, introducing surfacedisturbances or other alterations in structure or material within or onthe surface of the jacket 107 b can alter (e.g., enhance, augment, ordramatically enhance) the glowing appearance of the jacket 107 b. As anexample, the jacket 107 b may be constructed to have different degreesof transparency and/or different colors.

In any of the preceding embodiments, the color, brightness or otherparameter of the aiming beam may be varied to provide a different visualeffect. Typically, the aiming beam can have a red color, and this can beused with ferrules having clear transparencies (corresponding, forexample, to a color and transparency of water) or transparencies withslight hues of one or more colors, such as, for example, a transparentyellow ferrule).

FIGS. 12A, 12B, 12C and 12D show perspective, lengthwisecross-sectional, front-end, and transverse cross-sectional views ofcomponents (including ferrule 112) corresponding to the embodiment ofFIG. 12.

FIGS. 12E and 12F show side-elevation views of components (includingferrule 112 and output fiberoptic 107), and FIG. 12G shows a perspectiveview of components (including ferrule 112 and output fiberoptic 107) butwith the aiming beam “on” so that exposed parts of the output fiberopticand ferrule glow. According to one aspect of the present invention, thematerial of the ferrule can have a transparency of at least about 50%.According to another aspect, a transparency of the material of theferrule can be selected to be sufficient to allow a human naked eye tosee (e.g., clearly see) the bendable cannula 109 within the ferrule(c.f., lower-left fiberoptic of FIG. 12F).

The material of the ferrule 112, when formed into a planar sheet withsmooth surfaces and a thickness of about 5 mm, can have a 50%transparency, meaning, as used herein, that it will transmit about 50%of light from the cutting-beam laser (e.g., laser light having awavelength of 940 microns). This transparency may be altered, such as,for example, increased to any value up to a 100% transparency. Atransparency of the non-tinted ferrule of the lower-left replaceableoutput tip 108 shown in FIG. 12F can be (e.g., is) about 80% to 90%.

In a particular embodiment, about 85% of the cutting-beam laser lightexiting from the window 114 enters into the output fiberoptic 107 andabout 8% of it enters into the ferrule 112. Within the ferrule, abouthalf of it is absorbed and about half passes through.

Regarding the aiming beam, in a particular embodiment, about 50% of theaiming beam exiting from the window 114 enters into the outputfiberoptic 107 (cf. bottom-right depiction of FIG. 12H) and about 50% ofit enters into the ferrule 112. In one embodiment, within the ferrule, apercentage (e.g., about half) of it is absorbed and another percentage(e.g., about half) passes through, to create a glowing effect.

With reference to FIG. 12H, the solid cross-hairs at the center of theoutput fiberoptic (fiber) indicate an optical center thereof. Thesesolid cross-hairs also correspond to an optical center of thecutting-beam radiation (laser) that is projected onto the input end ofoutput fiberoptic. The phantom cross-hairs indicate an optical center ofthe aiming-beam radiation (aiming beam) that is projected onto theoutput fiberoptic. It can be discerned from the figure, in accordancewith an aspect of the invention, that the projection of aiming-beamradiation is not centered on the output fiberoptic, as a consequence ofthe depicted circles not being concentric and the cross-hairs havingdifferent positions. In modified embodiments, the spot size, opticalcenter as projected onto the output fiberoptic, and/or angle ofincidence onto the output fiberoptic, of the aiming beam may be variedto introduce more or less aiming-beam light into the ferrule and/or intothe output fiberoptic.

The aiming beam can comprise a wavelength of about 635 nm and, as itexits the window 114, can have a power of about 1 to 3 mW and a spotsize of about 600 microns. As indicated in FIG. 12 and in the lower-leftdepiction of FIG. 12H, the aiming beam can be configured and routed toimpinge on the output fiberoptic 107 at an angle, such as at an angle ofabout 15 degrees with respect to an optical axis of the outputfiberoptic. The aiming beam may comprise one or more of continuous wave(CW) and modulated energy.

According to an aspect of the present invention, the aiming beam can beoperated in a modulated mode at lower output (e.g., brightness) settingsand a CW mode at higher output (e.g., brightness) settings. As anexemplary embodiment, the aiming beam when modulated may comprise (1) amodulation frequency of about 50 Hz corresponding to a pulse period ofabout 20 ms, (2) a peak power of about 2 mW, and (3) a pulse duty cycle,defined as the pulse duration divided by the pulse interval, rangingfrom about 5% to about 70%. A particular implementation may comprisefirst, second, third and forth presets that output an aiming beam, withany one or more of the above-mentioned aiming beam parameters, withpulse duty cycles of 5, 10, 30 and 70, respectively, and may furthercomprise a fifth preset that outputs an aiming beam, with one or more ofthe above-mentioned aiming beam parameters, in a CW mode.

Another aspect of the present invention introduces structure and/oralgorithms for altering a visual, structural, or functionalcharacteristic of one or more of the ferrule 112, output fiberoptic 107,or any other component described herein (e.g., the display), to therebyprovide an indication to the user, following a predetermined number ofuses or amount of time of use of the output fiberoptic 107. Theindication communicates to the user that the output fiberoptic 107(e.g., the entire replaceable output tip 108) should be replaced.Feedback light can used to detect a change in feedback beam qualitycorresponding to a degradation (e.g., fraying) of a distal-most outputend of the output fiberoptic 107, the detection of which can trigger anoccurrence of the indication. The indication can also be triggered bythe occurrence of an autoclave procedure (for a single use limitation)or of a predetermined number of autoclave procedures (for a multiple-uselimitation), after which the output fiberoptic tip 107 should bereplaced wherein an adhesive used in the output fiberoptic 107 can beselected to degrade or disintegrate when subjected to the autoclaveprocedure or procedures. In another implementation, the ferrule 112 cancomprise a material that changes color after a predetermined amount ofuse time has occurred, thus providing the indication.

The output surface of the aiming beam fiber 115 can be truncated andpolished at a non-normal angle so that the output surface directs theaiming beam into the center of the output fiberoptic 107. A point on theoutput surface of the aiming beam fiber 115 intersected by the opticalaxis of the aiming beam fiber 115 can be referred to as an output point.With reference to FIG. 12, the angle A2 between the optical axis of theaiming beam fiber 115 and a path of output energy directed from theoutput point into the center of the output fiberoptic 107 may, forexample, be from about 10 to 20 degrees in an implementation wherein thecenter-to-center separation between the trunk optical fiber 73 and theaiming beam fiber is about 130 to 150 microns and the distance from theoutput end of the trunk optical fiber 73 to the input end of the outputfiberoptic 107 is about 300 to 700 microns. With regard to theillumination pattern shown in FIG. 13, a center 74 of the ring is filledwith irradiation from the trunk optical fiber 73, and the ring pattern76 corresponds to radiation from the aiming beam fiber 115. With thisirradiation pattern, a quality of the ring pattern can be used todetermine a quality of the beam or beams.

A core diameter of the trunk optical fiber 73 can be, for example, about105 microns, and a core diameter of the output fiberoptic 107 can be,for example, about 200, 300 or 400 microns. As embodied herein, thewindow 114 can comprise sapphire with an anti-reflective coating (ARC)on one or both of its sides. In a particular implementation, it cancomprise a thickness of about 250 microns and a diameter of about 2.5mm, and can have an ARC disposed on both of its circular surfaces. Otherstructures and materials may be implemented in modified embodiments,and, according to certain aspects, such modifications can maintain afunctionality of the optical interface of providing a thermal and/orthermal barrier while providing an optical pathway between the trunkoptical fiber 73 and the output fiberoptic 107. For example, a functionof the optical interface can be to dissipate heat to protect the trunkoptical fiber 73 output end from damage.

FIG. 14 provides examples of a number of typical bendable tip cannulas,comprising ferrules, which may comprise different colors to indicatedifferent characteristics, and which may be interchangeably affixed tothe handpiece 78.

As with typical prior-art implementations, the distal energy output endof the output fiberoptic 107 can exhibit signs of wear or damage afteruse (e.g., after about 5 minutes of actual lasing time), and thus shouldbe replaced on a frequent and regular basis. The replaceable output tip108 of the present invention can render such replacements rapid,reliable, efficient, sterile, and convenient. A typical cannula of theinvention, such as a typical bendable tip cannula 109, may comprise aone millimeter OD, a 0.1 millimeter wall thickness, and a 2.5 centimeterlength, with an inner lumen of the cannula accommodating an outputfiberoptic having, for example, a 400 micron diameter, whereby a lengthof the output fiberoptic protruding distally from the cannula may be,for example, about four to nine millimeters.

FIGS. 16 and 17 show perspective front and rear views of anelectromagnetic energy output device 171 in the form of a compact,portable assembly that can be carried or mounted with relative ease by auser. The electromagnetic energy output device 171 can comprise ahousing 173 with a removable base 175 and a removable spool 177. Theremovable base 175 can be detachably secured to the housing 173 usingany known means for providing a removable affixation, such as, referringto FIG. 19, a protuberance or rib 179 of the base 175 constructed toslidably fit into a slot or channel 181 of the housing 173. Inoperation, a user can lift the housing 173 above the removable base 175so that the channel 181 is positioned above the rib 179, as exemplifiedin FIG. 19. Subsequently, the user the user can lower the housing 173 insuch a way that the channel 181 contacts, is moved around, and envelopsat least a part of the rib 179, until the housing 173 is positioned onthe same plane (e.g., table top) on which the removable base 175 rests.

According to the embodiment of FIGS. 16 and 17, the electromagneticenergy output device 171 further comprises a fiber optic 176, whichextends from a point of the housing 173 to the removable spool 177 andwhich further extends to an output configuration 180. The outputconfiguration 180 is embodied in this example as a handpiece 151 havingan actuator control (not shown) for controlling, for example, an on/offstate of an electromagnetic energy source (e.g., laser) and furtherhaving an output fiberoptic which in the illustrated embodimentcomprises a replaceable output tip 183. A foot switch can be used in liuof the actuator for turning the laser on and off, and it can communicatewith the housing 173 using a wireless communication protocol, such asBluetooth® technology.

The electromagnetic energy output device 141 can be hand-held as can beseen with reference to FIG. 20B. The electromagnetic energy outputdevice 141 can also be wall or pole mounted as shown in FIG. 18, orpositioned on a table top as elucidated, for example, in FIGS. 16, 17,19 and 20A.

The housing 173 can comprise, for example, a display, such as atouchscreen 156, inputs or controls 159, an electromagnetic energysource such as a laser (not shown), and batteries (not shown) which maycomprise two sets of batteries. The electromagnetic energy source can bedisposed in a lower, rear portion of the housing 173. A power chord canbe implemented as an alternative, or in addition to, the batteries. In amodified embodiment, one or more of a size, shape and capacity of theremovable base 175 may be altered or enhanced to form an altered orenhanced removable base 175. An example of an altered base, such asdiscussed below and shown in FIGS. 26A and 26B, may be formed andimplemented for carrying the laser and/or one or more additional,optional lasers. As shown in FIGS. 21, 22, and others, when theremovable spool 177 is disposed (e.g., attached) in close proximity tothe housing 173, an extra length (e.g., one foot) of fiber optic 176 canbe stored in a trip-free (e.g., of reduced clutter) and organizedfashion. In modified embodiments, the removable spool 177 can be securedto (and, in other modified embodiments, secured and concealed, forexample, within) the housing 173), to thereby provide a technician oruser with a means of increasing a length of the fiber optic 176 byadvancing additional fiber optic 176 from the removable spool 177 towardthe handpiece 151 should the need arise. In a modified embodiment, theremovable spool 177 can be disposed, but not necessarily attached,outside of the housing 173 and/or in a vicinity of (e.g., adjacent to orinside of) the handpiece 151. Using this technique, a fiber optic 176length of, for example, 5 to 8 feet can be maintained in the event ofdamage, such as an overheating occurrence of the optical interface.

In accordance with an aspect of the current invention, the functionalityprovided by the disclosed arrangement can be accomplished without thenecessity of having the fiber optic 176 slidably disposed within thebendable tip cannula 109. Accordingly, and in contrast to the prior-artconstruction of FIG. 1, the output fiberoptic 107 can be permanentlyaffixed, such as by an adhesive, within the bendable tip cannula 109.

FIG. 26A depicts a particular implementation of a touchscreen and inputsor controls, wherein, for example, the center (e.g., 19.50w) display hasleft-facing and right-facing arrows for increasing and decreasingvarious parameters; here power is shown and the dark shaded part on thehemispherical dial shows graphically the degree of that setting comparedto the maximum value (cf. a speedometer). An Energy Start display canshow how much energy has been delivered total, and can be reset to zeroafter each use. The Energy Start feature does not have a cap and countsthe energy delivered. An Energy Total feature, on the other hand, cancount down from a preset total amount to be delivered. The Energy Totaldisplay can be programmed (or chosen from a preset) to specify a totalamount of energy (e.g., deliver in one periodontal pocket 5-10 J; forexample, it may take 10-15 seconds and typically will be one continuousshot, to be delivered). If too much energy is delivered, for example,overheating and/or removal of too much tissue may occur; the usertypically cannot see within the periodontal pocket, for example, and,furthermore, the patient may not be able to feel the pain in an overdosesituation.

Average Power can be calculated in real-time and displayed in J/s. Whilethe figures depict a touchscreen, the functionality of the currentsystem can also be obtained using the user-interface inputs at thebottom of the unit comprising an Enter input and four arrow inputs.According to an aspect of the present invention, a target-closeelectromagnetic energy emitting (e.g., lasing) device is disclosed. Anaspect of the present invention comprises moving forward, along a lineof delivery system component locations, components of the target-closelasing device. More particularly, components of the target-close lasingdevice are configured to be positioned more forwardly so that they aredisposed closer to the target, as compared to locations of components oftypical prior-art systems. In other words, a substantial number of theelements of the target-close lasing device, and in certainimplementations all of the elements of the device, according to certainaspects of the present invention, be operatively disposed in arelatively close proximity to the target. While referenced herein as alasing device, it is intended that the energy source be interpreted tocover electromagnetic energy sources in general rather than just lasersystems.

One feature of the present invention provides for the coupling of atarget-close lasing device to a non-horizontal surface. Horizontalsurface real-estate can be at a premium during lasing procedures, sothat movement (and subsequent repositioning) of the target-close lasingdevice from proximity of such surfaces can free-up the surfaces forother tools or uses. One or more components of the target-close lasingdevice may be, for example, mounted to or disposed on (as distinguishedfrom just being coupled) the non-horizontal surface. The one or morecomponents of the target-close lasing device may be mounted to ordisposed on the non-horizontal surface using one or more of fasteners,such as screws, clips, or straps. In certain embodiments, the one ormore components, and in some implementations, all of the components, ofthe target-close lasing device can be attached to a non-horizontalsurface of one or more of an operating table, an operating stand, anoperating chair, and a wall.

According to one modified embodiment, one or more components of anytarget-close lasing device described or referenced herein may be mountedor disposed to or on a horizontal surface.

Another feature of the present invention provides for the coupling of atarget-close lasing device to a living creature. When attached to aliving creature, the target-close lasing device does not, in certainimplementations, require a surface or mount for placement on a counteror mounting on wall. Accordingly, horizontal surfaces are conserved.Attachment of the target-close lasing device to a part of the body(e.g., the body, or clothing on the body) can, in addition to and/or asa consequence of alleviating a requirement for the target-close lasingdevice to be mounted on the surface of a floor, countertop, or wall,attenuate a number or length of required cables, a fatigue of the user,an apprehension of a patient, an amount of clutter in a procedural area,and an amount of set-up time and/or clean-up time of a procedure.

One or more components of the target-close lasing device may be mountedto or disposed on (as distinguished from just being coupled) the livingcreature. The one or more components of the target-close lasing devicemay be mounted to or disposed on the living creature with one or more offasteners, such as clips, bands, snaps, grooves, pockets, cases, ringsor straps. In certain embodiments, the one or more components, and insome implementations, all of the components, of the target-close lasingdevice can be attached to a user. As defined herein, the user may be,for example, a physician, technician, or other professional seeking toperform a procedure, or may be a recipient of the procedure such as apatient.

In typical implementations, the target-close lasing device can bemounted to a part of the user's body or clothing/apparel.

It has been discovered that, in conjunction with the coupling (e.g.,mounting) of a target-close lasing device to one or more of anon-horizontal surface, the body of a living creature, and clothing orapparel, implementation of battery power can enhance the coupling.Moreover, as compared to a conventional disposition of a lasing deviceon a horizontal support surface, it has been discovered that, in thecontext of coupling of the target-close lasing device to the mentionednon-horizontal surface or living creature, the of a user interface withfewer hard (physical) buttons and/or more of a display/software userinterface (e.g., comprising more soft key and/or touch screen inputs, ascompared to prior-art constructions) can facilitate a greater usabilityor versatility of the target-close lasing device due to, for example,the less-restricting physical nature of the coupling. Similarly, ascompared to a conventional lasing device, the coupling of thetarget-close lasing device to the mentioned non-horizontal surface orliving creature can provide greater operability and efficiency whenimplemented with shorter cables and/or fibers.

According to exemplary body-mount embodiments, the target-close lasingdevice can be mounted, for example, to a forehead of a user, and furthercan be mounted to one or more of an arm, a chest, and a finger of theuser. A typical arm mount may comprise affixation of the target-closelasing device to an upper arm of a user or attachment to a wrist of theuser. The target-close lasing device may be affixed to the user's upperarm using an arm band, or may be attached to the user's wrist using awrist strap or bracelet.

According to exemplary clothing/apparel-mount embodiments, thetarget-close lasing device can be mounted, for example, to a chest of auser, to a waist of the user, to a finger of the user, and to a templearea of the user.

Mounting of the target-close lasing device to the chest of the user maybe accomplished with, for example, a cross-chest strap, a holster-typeharness, a necklace, or a pocket of a shirt or vest.

Mounting of the target-close lasing device to the waist of the user canbe achieved by way of a belt. The target-close lasing device may beremovably attached to the belt using, for example, one or more of a clipand a holster.

Furthermore, the target-close lasing device may be coupled to a fingerof the user using, for example, a ring, a strap (e.g., which isstretchable and contractible, or which has a belt or hook-and-loopfastener) or a glove.

Regarding mounting of the target-close lasing device to a temple area ofthe user, this may be achieved by attachment of the target-close lasingdevice to, or integral formation with, glasses).

A possible net result of the current invention's implementation of atarget-close lasing system can be to at least partially, and in certainaspects, dramatically, enhance one or more of a safety (e.g., from asimpler assembly, less clutter on floor/table surfaces and/or lesslikelihood of user confusion/error), a versatility (e.g.,movement/maneuverability of the device to/in or use of the device inmore applications), and an efficiency (e.g., shorter fiber optic, lessassembly/disassembly).

Another possible net result of the implementation of a target-closelasing system according to the present invention can be to at leastpartially, and in certain aspects, dramatically, attenuate one or moreof a manufacturing cost (e.g., from more compact, fewer or shortercomponents), an operational and/or maintenance cost (e.g., from deliveryof energy over a smaller distance, resulting in fewer energy losesduring use), and a subjective element experienced by the patient duringa medical procedure (e.g., from more discrete and/or lessformidable-looking equipment, as compared to typical prior-art systems).

When, for example, an arrangement and orientation of the hand do notneed to be fixed and oriented in a way to hold and operate aconventional lasing device, the hand may have a smaller profile, forexample, and may be able to fit into or operate better in confinedspaces.

Following coupling of part or all of the components of a target-closelasing device to a part of the body of a user, such as the arm (e.g.,wrist), the user may not need to grip and hold, or may not need to gripand hold as much, the component(s), thus potentially freeing-up, orpartially freeing-up, one or more of a functionality and a profile ofthat hand. Furthermore, freeing-up of one or more fingers of the user'shand (e.g., by finger mounting the output configuration) can provide, orprovide further, that hand with one or more of a smaller profile and agreater procedural maneuverability or functionality. Thus, when notcommitted to the holding of a conventional laser handpiece, the user'shand may be used to perform other tasks as the user may not need to gripand hold as many components or may not need to grip and hold them to thesame extent. Thus, fingers of the user's hand may be free, or at leastpotentially less burdened, for the performance of other tasks.

A target-close lasing device according to the present invention can beembodied in the form of a body-mount implementation. The body-attachment(e.g., wrist mount) implementation of the target-close lasing device cancomprise, for example, a housing with a body attachment (e.g., a wristband), an output configuration for outputting electromagnetic radiation,and a wave guide (e.g., fiber optic) for delivering electromagneticradiation from the housing to the output configuration. In certainembodiments of the present invention, the output configuration may takethe form of, for example, one or more of a thumbpiece, a fingerpiece, afiber optic tip, and a distal end (e.g., a distal part) of a fiberoptic.

One or more of the housing and output configuration, and/or anycomponent thereof, may be disposable. A typical power output maycomprise, for example, 0.5 W to about 2.0 W.

Any combination or permutation of components, systems and steps of or inconnection with any target-close lasing device described or referencedherein can be used or implemented, to any extent and in any combinationor permutation, with any one or more of the components, systems andsteps disclosed or referenced in U.S. application Ser. No. 11/330,388,filed Jan. 10, 2006, the entire contents of which are expresslyincorporated herein by reference. For example, fluid (e.g., atomizedfluid particles) can be placed into an interaction zone in front of, forexample, any of the output configurations disclosed herein forabsorption of electromagnetic radiation and for subsequent expansion toimpart an effect (e.g., mechanical cutting forces) onto a target.

Moreover, any one or more of the described or referenced thumbpiece,fingerpiece, fiber optic tip, and distal end of a fiber optic may beprovided with one or more of an air and a fluid (e.g., water) line asdescribed, for example, in the referenced U.S. application Ser. No.11/330,388. An air and/or fluid (e.g., water) source may be provided inthe form of one or more receptacles (e.g., pressurized cartridges) whichmay be coupled with (e.g., attached to or housed in) one or more of thecomponents described or referenced herein, such as a housing, thumbpieceor fingerpiece.

Any combination or permutation of components, systems and steps of or inconnection with any target-close lasing device described or referencedherein can be used or implemented, to any extent and in any combinationor permutation, with any one or more of the components, systems andsteps disclosed or referenced in U.S. application Ser. No. 11/475,719,filed Jun. 26, 2006, the entire contents of which are expresslyincorporated herein by reference. For example, a visual feedbackimplement (e.g., camera) can be disposed in proximity to (e.g., on orwithin and/or at a distal part thereof) one or more of the described orreferenced housing, thumbpiece, fingerpiece, fiber optic tip, and distalend of a fiber optic. According to one example, any one or more of thedescribed or referenced thumbpiece, fingerpiece, fiber optic tip anddistal end of the fiber optic may be provided with one or more of awater line and a visual feedback implement.

According to an aspect of the present invention, one or more componentsof the output configuration, in any combination, may be bendable and/orrigid. In bendable embodiments, the bendable component or components maycomprise a bendable medical grade plastic and/or in rigid embodiments,the rigid component or components may comprise a rigid medical gradeplastic or glass. For example, any one or more of the thumbpiece,fingerpiece and fiber optic tip may be bendable. Any such bendableoutput configuration may comprise one or more of rigid, semi-flexible,or flexible components.

Each of the thumbpiece, fingerpiece and fiber optic may be bendable(e.g., upon application of bending forces by a hand of a user) so that athe optical axes of two portions (e.g., adjacent portions) thereof arechanged by about one or two degrees, or in modified embodiments by up toabout 10 degrees, or in other modified embodiments by up to about 30degrees, or in further modified embodiments by up to about 90 degrees,or in still further modified embodiments by up to about 180 degrees ofthe output configurations may be, according to certain implementations,configured to be bent only once, only a few (e.g., about 2 to 11) ormany (e.g., about 12 or more) times, and/or may be structured to returnback, either partially or fully, to an original, pre-bent configurationeither upon application of external forces (e.g., by a hand of a user)or under its own memory.

In another aspect of the present invention, one or more of a housing andan output configuration may comprise one or more of a coating, a layerand a solid or substantially solid material. The term substantiallysolid, can be interpreted to refer to a construction wherein the housingand/or output configuration does not have a relatively large, e.g.,greater than 10 percent, interior that is not formed of the material.According to certain examples, thicknesses of the coatings or layers canbe about 1% to about 50% of the radius or width, for example, of themember being coated or layered.

The material may comprise, for example, a moldable or pliable material.In particular implementations, the moldable or pliable material may bemoldable or pliable in response to a pressure applied by a hand of auser. The moldable or pliable material may assume a new characteristicor shape in response to the applied pressure, and such newcharacteristic may be temporary or permanent.

In certain examples, the moldable or pliable material may be configuredto be formed (e.g., molded) only once, only a few (e.g., about 4 or 5)or many (e.g., about 6 or more) times, and/or may be structured toreturn back, either partially or fully, to an original, pre-formedconfiguration either upon application of an additive (e.g., by forcesfrom a hand of a user and/or upon an application of heat) or under itsown memory. In particular implementations, the material can comprise afoam. In other constructions, the material may comprise a memorymaterial.

According to still further implementations, the material may comprise amemory foam material, similar to or the same as any know memory foammaterial used in connection with the fabrication or use of a mattress orear plugs. Furthermore, and/or alternatively, the material may assume anenhanced moldability or pliability upon the introduction of an additive,such as heat (e.g., heat from a blow dryer or from a hand of a user).

One or more rigid structures may be provided with the layered, coated orsolid housing or output configuration. For example, in a constructionwherein one or more of the housing and output configuration comprise asolid or substantially solid material, an internal support member (e.g.,bar) may be provided in a center part of the housing or outputconfiguration. In another construction, wherein one or more of thehousing and output configuration comprise a solid or substantially solidmaterial, an internal support shell (e.g., spanning under and/orcontacting at least a part of a coating or layer of the material) may beprovided.

Furthermore, according to another aspect of the present invention, oneor more of the housing and the output configuration can be constructedwith one or more of an application specific integrated circuit (ASIC)and a microprocessor. The microprocessor or microprocessors may beenabled, for example, for wireless communication of, for example,operating states and configurations of the target-close lasing device.The wireless communications may be performed using, for example,Bluetooth® architectures and protocols, and/or the microprocessor ormicroprocessors may furthermore, or alternatively, be configured totransfer or upload data of, for example, previously acquired orreal-time operating information.

With regard to FIGS. 27-44, these drawings are intended to be examplesof implementations of various aspects of the present invention and areintended, according to certain but not all embodiments, to be to-scale.That is, according to certain implementations, the structures depictedin these figures may be interpreted to be to scale, but in otherimplementations they may not. In certain aspects of the invention, useof the same reference designator numbers in these drawings and thefollowing description is intended to refer to similar or analogous, butnot necessarily the same, components and elements. According to otheraspects, use of the same reference designator numbers in these drawingsand the following description is intended to be interpreted as referringto the same or substantially the same, and/or functionally the same,components and elements.

In certain constructions of target-close lasing devices, for example,lengths of thumbpieces, in the depicted exemplary embodiments set outbelow, can be about one inch. In other examples, the overall lengths canbe about 2 inches. In other implementations, maximum widths of thethumbpieces can be about 3/10 of an inch. Inner diameters of distal,radiation output ends of any of the embodiments described, referenced ordepicted herein may be, for example, about 50 microns to about 2000microns. Fiber optic tips, according to one feature of the presentinvention, can be formed (e.g., of solid glass) with radiation outputorifices of 3-10 mm corresponding, for example, to photobiomodulation orlow-level light therapy (LLLT) embodiments. Regarding low-level lighttherapy techniques, any combination or permutation of components,systems and steps of or in connection with any target-close lasingdevice described or referenced herein can be used or implemented, to anyextent and in any combination or permutation, with any one or more ofthe components, systems and steps disclosed or referenced in U.S.Application Ser. No. 11/447,605, filed Jun. 5, 2006, the entire contentsof which are expressly incorporated herein by reference.

With reference to FIG. 27, a target-close lasing device is exemplifiedin the form of a body-mount implementation. The body-attachment (e.g.,wrist mount) implementation of the target-close lasing device 141 cancomprise a housing 143 with a body attachment (e.g., a wrist band) 145,a fiber optic 148, and an output configuration. The housing cancomprise, for example, a display, such as a touchscreen 156, inputs orcontrols 159, an electromagnetic energy source such as a laser 161, andbatteries 164 which may comprise two sets of batteries.

The output configuration is embodied in this example as a handpiece 151with an actuator control 152 for controlling, for example, an on/offstate of an electromagnetic energy source (e.g., laser) and with a fiberoptic tip 153. In the current or other embodiments described orreferenced herein (e.g., an embodiment wherein the output configurationtakes the form of only a fiber optic tip or of only a distal end of thefiber optic, either embodiment being formed alone or in conjunction witha fluid output), the actuator control may be omitted in lieu of a footpedal and/or other controls. Moreover, the actuator may take the form ofa greater number of input acceptors (e.g., buttons), rather than justthe single button depicted in FIG. 27.

FIGS. 28-31 depict examples of output configurations embodied asthumbpieces. Typically, according to various embodiments, thumbpiecesmay be configured to be smaller than handpieces. In certainimplementations, thumbpieces may have one or more of lengths, and widthsor diameters, that are smaller than corresponding dimensions ofhandpieces. The thumbpiece 172 of FIG. 28 comprises a body 174, a fiberoptic tip 176, and a body extension 178. Similarly, the thumbpiece 182of FIG. 29 comprises a body 184, a fiber optic tip 186, and a bodyextension 168.

The thumbpiece 192 of FIG. 30 comprises a body 194 having a radiationoutput end 196, and further comprises a body extension 198. Similarly,the thumbpiece 202 of FIG. 31 comprises a body 204 having a radiationoutput end 206, and further comprises a body extension 208. Certainimplementations, such as those depicted in FIGS. 28 and 29, may comprisefiber optic tips, and certain implementations, such as those depicted inFIGS. 30 and 31, may not. The embodiments of FIGS. 28 and 29 may,alternatively, be formed without fiber optic tips, and theimplementations of FIGS. 30 and 31 may, alternatively, be provided withfiber optic tips.

In any implementation described or referenced herein, the outputconfiguration (e.g., thumbpiece) may be formed to comprisedifferent-shaped features/protuberances thereon. For example, as shownin FIGS. 28 and 29, wings (cf. the location in FIG. 29 touched by theleadline of reference designator number 184) may be provided on thethumbpiece to aid, for example, in one or more of holding ability andmaneuverability of the thumbpiece. One or more of thefeatures/protuberances may be removably and/or interchangeably (e.g.,with other features or with no other features) disposed on thethumbpiece.

According to various aspects of the invention, any implementationdescribed or referenced herein may be provided with a body extension,either attached (e.g., bonded) or integrally formed therewith (e.g., sothat a body is provided with an elongate proximal part). Furthermore, inany implementation described or referenced herein, the body extensionmay be omitted, or provided in longer, shorter, thicker, thinner, ordifferent-shaped implementations, and/or may be removable. The outputconfiguration may be operable with the body extension attached or withit removed, according to a preference or need of the user. In otherembodiments, various body extensions, such as described above, may beinterchangeably affixed to the output configuration. Omission of a bodyextension may, according to an aspect of the present invention, renderinclusion of a feature/protuberance more advantageous.

In use, the user can grip and hold the output configuration with his orher thumb and two fingers (such as is conventional in the art forholding, for example, a writing implement). According to certain but notall implementations, a proximal part of the output configuration and/ora part of the fiber optic, can rest on, or be attached to, a portion ofthe hand bridging the user's forefinger and thumb. In modifiedimplementations, the user can grip and hold the output configurationwith his or her thumb and one finger, such as his or her index finger,whereby, in certain but not all implementations a proximal part of theoutput configuration and/or a part of the fiber optic can rest on, or beattached to, a portion of the hand bridging the user's forefinger andthumb.

According to another aspect of the present invention, a radiation outputend of the output configuration of any embodiment described orreferenced herein may be provided with a mechanical contacting orcleaning implement. For example, any one or more of the thumbpiece,fingerpiece and fiber optic tip may be provided with a contactingstructure, such as a brush. FIG. 28 shows a fiber optic tip 176comprising a brush at a distal, radiation output end thereof.

An embodiment wherein the housing is integrated into the outputconfiguration is depicted in FIG. 32, and an embodiment wherein theoutput configuration comprises just the fiber optic is elucidated inFIG. 33. Regarding the ring shown in this figure, it may be implementedin modified embodiments with other output configurations, as well, suchas those depicted or referenced in this application, in any combinationor permutation. FIGS. 34-36 depict various output configurations in theform of fingerpieces. The embodiments of FIGS. 34 and 35 may bealternative embodiments or part of the same embodiment. A distal end 154may output radiation or may be coupled to an output fiber tip foroutputting radiation. FIGS. 37-44 depict various housings secured tovarious areas of the user and/or clothing or apparel of the user. Theimplementation of FIG. 43 depicts a housing suspended from a strap orband, which may comprise, for example, a necklace or a bracelet, or astrap placed around an inanimate object such as a light, chair, orstand.

In the presently described and any other embodiment set forth herein,the fiber optic may have a length, for example, of about eight inches,and in a modified embodiment may have a length of about a foot, and inanother modified embodiment may have a length of about two to about fivefeet.

Certain implementations, such as those comprising fiber optics of abouta foot, or those comprising fiber optics of about two to five feet, maybe provided with a housing or output configuration having a retractingdevice, such as a spool for retracting a length of the fiber optic. Thephantom circular structure of FIGS. 40 and 41 elucidates a spool forretractably and extendably holding a fiber optic. These two figures alsoelucidate a housing having a port or other storage area for housing theoutput configuration (e.g., thumbpiece) therein. In modifiedembodiments, the port, pocket, groove, or housing may comprise adisposable sheath lining an interior surface thereof. The sheath maycomprise a thin, transparent membrane, for example, which can beremoved, disposed and replaced between uses. In further embodiments, theoutput configuration may be attached, such as by a grooves (andprotruding, mating rib structures on the opposite surface), snaps,and/or or hook-and-loop fasteners, to the housing.

The removable spool 177 can comprise, for example, two parts, as shownin FIGS. 23 and 24, to provide storage and protection to the fiber optic176. In the exemplary implementation shown in FIGS. 21-25B, theremovable spool 177 comprises a spool enclosure 177A and a rubberenclosure 177B. The rubber enclosure 177B can comprise a rubber hub, asdepicted, which clips onto the spool enclosure 177A and which controlswinding and unwinding of the fiber optic 176. A domed interior of thespool enclosure 177A allows coils of the fiber optic 176 to expand inthe chamber. With reference to FIG. 24, in certain implementations fiberoptic 176 which is wrapped around the removable spool 177 is unspooledand released as a user pulls the handpiece away from the removable spool177. Referring to FIG. 25A, during winding, the rubber enclosure 177B(e.g., rubber hub) directs windings of the fiber optic 176 inward andsupplies containment pressure. Referring to FIG. 25B, it can be seenthat, during unspooling, pulling of optical fiber 176 out of the spoolcauses the rubber enclosure 177B (e.g., rubber hub) to deflect away fromthe spool enclosure 177A, allowing the fiber optic 176 within theremovable spool 177 to spill out automatically so that the user does notneed to manually unwind the fiber optic 176 from the removable spool177.

The laser module 69 of, for example, FIGS. 25A and 25B, can comprise adiode laser. The diode laser of the system can be disposed near thebottom of the housing 173, and the removable base 175 can serve as aheat sink. Additional lasers can be added into the bottom of the housing173, into the base 175, and/or, according to the modified implementationshown in FIGS. 26A and 26B, referenced above, a base 186 can be formed(e.g., restructured, as shown, to provide a larger interior) to providea greater volume for the additional lasers. Also, the base 186 can beformed to have extra ribs or other heat dissipating structures.

In view of the foregoing, it will be understood by those skilled in theart that the methods of the present invention can facilitate formationof laser devices, and in particular diode laser systems. Theabove-described embodiments have been provided by way of example, andthe present invention is not limited to these examples. Multiplevariations and modification to the disclosed embodiments will occur, tothe extent not mutually exclusive, to those skilled in the art uponconsideration of the foregoing description. Such variations andmodifications, however, fall well within the scope of the presentinvention as set forth in the following claims. Additionally, othercombinations, omissions, substitutions and modifications will beapparent to the skilled artisan in view of the disclosure herein. Asiterated above, any feature or combination of features described andreferenced herein are included within the scope of the present inventionprovided that the features included in any such combination are notmutually inconsistent as will be apparent from the context, thisspecification, and the knowledge of one of ordinary skill in the art.For example, any of the lasers and laser components including outputconfigurations, and any particulars or features thereof, or otherfeatures, including method steps and techniques, may be used with anyother structure and process described or referenced herein, in whole orin part, in any combination or permutation. Accordingly, the presentinvention is not intended to be limited by the disclosed embodiments,but is to be defined by reference to the following claims.

1. An apparatus, comprising: an output configuration formed as one ormore of a thumbpiece, a fingerpiece and a handpiece, and furtherincluding batteries, an electromagnetic energy source actuatable by auser to output electromagnetic radiation, a fluid output configured todeliver fluid from a distal end of the output configuration, a firstcircuit, a wireless transmitter and receiver, and a sterile output endconstructed to deliver ablating or therapeutic radiation from theelectromagnetic energy source to a target; and a housing including, asecond circuit, a graphical user interface having a display and one ormore of user inputs and user controls, and a wireless transmitter andreceiver that is configured to wirelessly communicate one or more ofoperating states, configurations and real-time operating informationwith the first circuit.
 2. The apparatus as set forth in claim 1,wherein the radiation is pulsed.
 3. The apparatus as set forth in claim1, wherein the output configuration is sized and shaped to fit onto auser's finger.
 4. The apparatus as set forth in claim 1, wherein theoutput configuration does not contact and is not hard-wire or physicallyconnected to the housing.
 5. The apparatus as set forth in claim 1,wherein the output configuration comprises a laser.
 6. The apparatus asset forth in claim 1, the output configuration comprising an outersurface with a protuberance disposed thereon for facilitating one ormore of holding and gripping by a hand of a user.
 7. The apparatus asset forth in claim 6, wherein the protuberance is a wing.
 8. Theapparatus as set forth in claim 1, wherein the apparatus is configuredto output laser energy having a wavelength of about 915 nanometers,about 940 microseconds, about 960 nanometers, or about 980 nanometers,and wherein the apparatus is configured to output the laser energy in acontinuous wave or quasi-continuous wave mode.
 9. The apparatus as setforth in claim 1, wherein the apparatus is configured to output pulsedlaser energy with a pulse duration of about 50 microseconds or less anda pulse interval of about 450 microseconds or more.
 10. The apparatus asset forth in claim 1, wherein the apparatus is configured to outputpulsed laser energy with an independently adjustable pulse duration thatcan be adjusted independently of the pulse interval.
 11. The apparatusas set forth in claim 1, wherein the apparatus is configured to outputpulsed laser energy with an independently adjustable pulse interval thatcan be adjusted independently of the pulse duration.
 12. The apparatusas set forth in claim 1, wherein the output configuration is portableand is battery operated.
 13. The apparatus as set forth in claim 1,wherein the output configuration comprises a fiber optic extending froma distal end of the output configuration.
 14. The apparatus as set forthin claim 1, wherein the output configuration comprises a touchscreendisplay.
 15. The apparatus as set forth in claim 1, wherein the outputconfiguration comprises a brush disposed at a distal end of the outputconfiguration.
 16. The apparatus as set forth in claim 1, wherein thehousing comprises one or more of a port and a pocket for removeably andnondestructively holding a distal end of the output configuration. 17.The apparatus as set forth in claim 16, wherein the port or pocketcomprises a single-use disposable sheath lining an interior surfacethereof.
 18. The apparatus as set forth in claim 17, wherein thedisposable sheath comprises a thin, transparent membrane that can beremoved, disposed and replaced between uses.
 19. The apparatus as setforth in claim 1, wherein the housing is provided with a groove forremoveably and nondestructively holding a distal end of the outputconfiguration and wherein the distal end of the output configuration hascorresponding protruding and mating rib structure for engaging thegroove.